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Montana rates for HCPCS A9569

Technetium Tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose

Facilitymedian $3,090 · 10th–90th $51–$3,9810%50%10th90th$3,090Professionalmedian $1,698 · 10th–90th $1,660–$3,0900%50%10th90th$1,698$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,698.24 / $1,737.80
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,691.53 / $3,981.07 / $10,232.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $2,818.38
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $3,090.30 / $3,090.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $3,090.30 / $3,090.30
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,818.38 / $10,232.93
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $1,698.24 / $3,715.35
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $1,698.24